Traa Maria X, Barboza Lorena, Doron Shira, Snydman David R, Noubary Farzad, Nasraway Stanley A
1Department of Surgery, Tufts Medical Center, Tufts University School of Medicine, and Tufts Clinical and Translational Science Institute, Boston, MA. 2Division of Infectious and Geographic Diseases, Tufts Medical Center, Tufts University School of Medicine, and Tufts Clinical and Translational Science Institute, Boston, MA. 3Department of Medicine and the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, and Tufts Clinical and Translational Science Institute, Boston, MA.
Crit Care Med. 2014 Oct;42(10):2151-7. doi: 10.1097/CCM.0000000000000501.
Methicillin-resistant Staphylococcus aureus infection is a significant contributor to morbidity and mortality in hospitalized patients worldwide. Numerous healthcare bodies in Europe and the United States have championed active surveillance per the "search and destroy" model. However, this strategy is associated with significant economic, logistical, and patient costs without any impact on other hospital-acquired pathogens. We evaluated whether horizontal infection control strategies could decrease the prevalence of methicillin-resistant S. aureus infection in the ICU, without the need for active surveillance.
Retrospective, observational study in the surgical ICU of a tertiary care medical center in Boston, MA, from 2005 to 2012.
A total of 6,697 patients in the surgical ICU.
Evidence-based infection prevention strategies were implemented in an iterative fashion, including 1) hand hygiene program with refresher education campaign, 2) chlorhexidine oral hygiene program, 3) chlorhexidine bathing, 4) catheter-associated bloodstream infection program, and 5) daily goals sheets.
The prevalence of methicillin-resistant S. aureus infection fell from 2.66 to 0.69 per 1,000 patient days from 2005 to 2012, an average decrease of 21% per year. The biggest decline in rate of infection was detected in 2008, which may suggest that the catheter-associated bloodstream infection prevention program was particularly effective. Among 4,478 surgical ICU admissions over the last 5 years, not a single case of methicillin-resistant S. aureus bacteremia was observed.
Aggressive multifaceted horizontal infection control is an effective strategy for reducing the prevalence of methicillin-resistant S. aureus infection and eliminating methicillin-resistant S. aureus bacteremia in the ICU without the need for active surveillance and decontamination.
耐甲氧西林金黄色葡萄球菌感染是全球住院患者发病和死亡的重要原因。欧美众多医疗机构倡导按照“查找并清除”模式进行主动监测。然而，该策略会带来巨大的经济、后勤和患者成本，且对其他医院获得性病原体没有任何影响。我们评估了横向感染控制策略能否在无需主动监测的情况下降低重症监护病房（ICU）中耐甲氧西林金黄色葡萄球菌感染的发生率。
对2005年至2012年马萨诸塞州波士顿一家三级医疗中心外科ICU进行回顾性观察研究。
外科ICU共有6697例患者。
以迭代方式实施基于证据的感染预防策略，包括1）手部卫生计划及再培训教育活动，2）洗必泰口腔卫生计划，3）洗必泰沐浴，4）导管相关血流感染预防计划，以及5）每日目标清单。
2005年至2012年，耐甲氧西林金黄色葡萄球菌感染的发生率从每1000患者日2.66例降至0.69例，平均每年下降21%。2008年感染率下降幅度最大，这可能表明导管相关血流感染预防计划特别有效。在过去5年的4478例外科ICU入院患者中，未观察到一例耐甲氧西林金黄色葡萄球菌菌血症病例。
积极的多方面横向感染控制是一种有效的策略，可降低ICU中耐甲氧西林金黄色葡萄球菌感染的发生率，并消除耐甲氧西林金黄色葡萄球菌菌血症，而无需主动监测和去污。
